Enteral nutrition with simultaneous gastric decompression in critically ill patients

Objective: Early enteral nutrition is an important adjunct in the care of critically ill patients. A double-lumen gastrostomy tube with a duodenal extension has been reported to enable early enteral feeding with simultaneous gastroduodenal decompression. We tested the ability of this device to achieve these goals in critically ill patients. Design: Noncomparative, descriptive case series. Setting: Surgical intensive care unit in a university hospital. Patients: Fifteen consecutive critically ill patients, who, at the time of laparotomy, were assessed likely to need long-term nutritional support and gastric decompression, underwent tube placement. Mean age was 47 ± 21 yrs. Mean Acute Physiology and Chronic Health Evaluation (APACHE II) and Therapeutic Intervention Scores were 15 ± 7.3 (SD) and 29 ± 10.2, respectively, and the mean Injury Severity Score of 11 trauma patients in the group was 27 ± 7.4. Interventions: Correct tube positioning was verified by radiograph or endoscopy. Methods: Caloric and protein requirements, nutritional parameters, and problems encountered with the device were recorded. The correlation between the volume of feeding port input and suction port output was noted, and this correlation was considered significant if r² was ≥.5. Results: Only three (20%) of 15 patients reached full enteral nutritional support via the enteral route. None of these patients achieved this level of nutritional support within the first postoperative week. In 67% of the patients, large quantities of enteral feeding solution appeared in the gastroduodenal suction port effluent. When feeding port input was plotted against effluent volume, a correlation coefficient of >.71 (r²=≥.5) was found in 40% of the patients. Other complications included: a) excessive gastroduodenal drainage requiring fluid/electrolyte replacement in eight (53.3%) patients; and b) skin ulceration at the tube entrance site in seven (46.7%) patients. Conclusions: These data do not support the use of this device for early enteral feeding and simultaneous gastric decompression in critically ill patients.